GYNAECOLOGICAL PROBLEMS IN THE ELDERLY

1

OSTEOPOROSIS:

• In the first 4 Years after menopause – annual bone loss of 1-3% fallen to 0,6% per year.

• ↑ Risk in – Wrist fractures

- Vertebral Body

- Upper femur

• 40% of patients > 65 year will have 1 or more fractures.

• Important consequence for women health

• UK 35 000 Post menopausal woman – hip fracture every year → 17% die in hospital

2

3

UROGYNAECOLOGICAL PROBLEMS

• URINARY INCONTINENCE:

TYPES:

(1) Stress incontinence

(2) Overactive bladder

(3) Retention with overflow

(4) Fistula

4

STRESS INCONTINENCE (SUI):

• Commonness – 60 – 70% of cases

• SUI is a sign or a symptom

• SUI is leakage when there is rise in with abdominal pressure

5

OVERACTIVE BLADDER

• Incontinent in response to an involuntary detrusor contraction.

• 30% of cases.

• Women experience urgency, and she cannot reach toilet and the bladder contraction persist – she will be incontinent.

• Problem happens day and night – Complains of frequency and nocturia.

6

RETENTION AND OVERFLOW:

• Common in elderly female patients.

• Denervatred bladder continues to fill until it simply spills over.

7

TREATMENT OPTIONS FOR URINARY INCONTINENCE

1. Conservative treatment (lifestyle interventions and bladder retraining).

2. Physiotherapy.

3. Drug therapy.

4. Surgery.

8

DRUG THERAPY: (OAB)

• Conservative measurements + Physiotherapy – help 3 out of 4.

• MEDICAL TREATMENT:

• Antimuscarimes of anticholinergic agent.

• 50% of women up to 50% improvement.

9

SUI:

• Estrogens.

• Vaginal estrogens should be prescribed to all women with urinary incontinence who are post menopausal.

10

MANAGEMENT:

• SUI:

(1) Anterior colporrhaphy.

(2) Colposuspension (Burch).

(3) TVT / T.O.T

11

12

GENITAL PROLAPS:

13

14

15

16

17

18

MANAGEMENT:

• Conservative:

• Pelvic floor exercises are not effective when prolaps is well established.

• Do have roll in treatment if associated urinary incontinences.

19

PESSARIES ARE COMMONLY USED:

20

21

22

SURGERY:

1. Anterior Colporrhaphy.

2. Posterior Colporrhaphy.

3. Vault prolaps - Abdominal

- Vaginal approach

23

CANCER:

1. ENDOMETRIAL CA:

• Second most common gynae cancer in UK.

• Incidence low < 40 year C<2: 100 000) age 40-55 (44:100000)

24

CLINICAL FEATURE:

• Post menopausal bleeding.

• 5-10% of PMB will have primary or secondary malignancy

- (88% endometrial CA).

- Cervix CA

- Ovaria CA

• Less common presentation → vaginal discharge.

• Endometrial CA – can also present with abnormal cell on papsmear.

25

26

27

28

LICHEN SCLEROSIS

29

VIN (VULVAL INTRA EPITHELIAL NEOPLASIA):

30

VULVA CARCINOMA:

• History of long standing vulval irritation or persists.

• Some previous history of Lichen Sclerosis.

• Lump or ulcer is common.

31

32

33

34

35

36

VULVA CARCINOMA

37